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Fillable Printable Application for Marriage License or Certificate - Hawaii

Fillable Printable Application for Marriage License or Certificate - Hawaii

Application for Marriage License or Certificate - Hawaii

Application for Marriage License or Certificate - Hawaii

Your marriage record is vital.
Be sure the information you give is complete and accurate.
PLEASE PRINT USE BLACK INK
MARRIAGE LICENSE APPLICATION
TO BE FILLED OUT BY COUPLE MAKING APPLICATION
(Please read instructions on reverse side of this form)
STATE OF HAWAI’I DEPARTMENT OF HEALTH
OFFICE OF HEALTH STATUS MONITORING
LICENSE NO.
APPLICANT I
Zip Code
Groom
Bride
Spouse
1a. FIRST NAME OF APPLICANT I b. MIDDLE NAME c. LAST NAME
1d. SOCIAL SECURITY NO.
2. DATE OF BIRTH (Month, Day, Year)
CITY
b. COUNTY
c. STATE OR FOREIGN COUNTRY
4. PLACE OF BIRTH: *City & State/Country
5. FATHER: a. FULL NAME FIRST, MIDDLE, LAST
b. STATE OR FOREIGN COUNTRY OF BIRTH*
c. Living?* Yes, No,
Refused, or Unknown
6. MOTHER: a. FULL NAME FIRST, MIDDLE, MAIDEN NAME
b. STATE OR FOREIGN COUNTRY OF BIRTH*
c. Living?* Yes, No,
Refused, or Unknown
APPLICANT II
Zip Code
Groom
Bride
Spouse
7a. FIRST NAME OF APPLICANT II b. MIDDLE NAME c. LAST NAME
7d. SOCIAL SECURITY NO.
8. DATE OF BIRTH (Month, Day, Year)
CITY
b. COUNTY
c. STATE OR FOREIGN COUNTRY
10. PLACE OF BIRTH: *City & State/Country
11. FATHER: a. FULL NAME FIRST, MIDDLE, LAST
b. STATE OR FOREIGN COUNTRY OF BIRTH*
c. Living?* Yes, No,
Refused, or Unknown
12. MOTHER: a. FULL NAME FIRST, MIDDLE, MAIDEN NAME
b. STATE OR FOREIGN COUNTRY OF BIRTH*
c. Living?* Yes, No,
Refused, or Unknown
Blood relationship of Applicant I
to Applicant II:
In what county do you plan to be married?
(Honolulu, Hawai’i Maui,
or Kaua’i County)
When do you plan to be married?
Name of Marriage Performer (Commissioned by the State of Hawai’i)
FORWARDING ADDRESS:
(After Marriage)
DO YOU WANT YOUR NAMES YES NO
PRINTED OR POSTED ELECTRONICALLY IN THE NEWSPAPER?
E-MAIL ADDRESS:
HOME/CELL PHONE NUMBER:
WORK PHONE NUMBER:
CONFIDENTIAL INFORMATION PLEASE COMPLETE
SUPPLEMENTARY
DATA
NO. OF THIS
MARRIAGE/OTHER
LEGAL UNION
CURRENTLY
IN CIVIL UNION OR
OTHER LEGALLY
RECOGNIZED
UNION WITH SAME
PARTNER?
IF PREVIOUSLY MARRIED OR IN OTHER LEGALLY RECOGNIZED
UNION, LAST MARRIAGE/OTHER LEGAL UNION ENDED.
RACE*
OCCUPATION*
EDUCATION* -
Specify Highest
Grade
Completed
SEX
FIRST, SECOND,
ETC. (SPECIFY)
BY DEATH, DIVORCE,
DISSOLUTION,
ANNULMENT OR
TERMINATION (specify)
DATE ENDED
PLACE ENDED
(COUNTY & STATE)
MONTH YEAR
APPLICANT I
21a.
21b.
22a.
22b.
22c.
23.
24.
25.
26.
APPLICANT II
27a.
27b.
28a.
28b.
28c.
29.
30.
31.
32.
FOR OFFICE USE ONLY
CERTIFICATION - SIGN BEFORE MARRIAGE AGENT
APPLICANT I:
SIGHTED:
#:
NAME ? Yes No
DOB ? Yes No
AGE: Sex: M F
Previous Marriage(s)/Legal
Union(s):
APPLICANT II:
SIGHTED:
#:
NAME ? Yes No
DOB ? Yes No
AGE: Sex: M F
Previous Marriage(s)/Legal
Union(s):
We, the undersigned, certify that the information given in this application is true and correct to be best of our knowledge and belief.
FULL SIGNATURE OF APPLICANT I
FULL SIGNATURE OF APPLICANT II
Sworn and subscribed to before me this day of , 20
MARRIAGE LICENSE AGENT JUDICIAL DISTRICT, STATE OF HAWAI’I
OHSM-1 ITEMS INDICATED WITH * ARE OPTIONAL, BUT DO NOT LEAVE THESE ITEMS BLANK; ENTER REFUSED INTENTIONAL FALSIFICATION IS A CRIME
TO BE FILLED OUT JOINTLY BY COUPLE MAKING APPLICATION
(Do not make separate applications for Applicant I and Applicant II.)
REQUIREMENTS FOR OBTAINING A MARRIAGE LICENSE
In applying for a marriage license, both applicants must appear in person before
a marriage license agent.
A marriage license is issued immediately after the application is made. After
being issued, the license expires within 30 days and it is valid statewide.
To marry, both applicants must be at least 15 years of age. Applicants who are
16 or 17 years of age must have the written consent of both parents, or of the legal
guardian, or other person in whose care and custody the minor has been placed, or of
the family court judge who has jurisdiction over the minor child. Applicants may marry
at age 15 years with the written consent of both parents or legal guardian and the
written approval of the judge of the family court. No one under 15 years of age may
marry.
Proof of age in the form of a certified copy of a birth certificate must be presented
to the marriage license agent by any applicant who is under 19 years of age. Proof of
age may be requested for those applicants over 18 in the form of an I.D. or driver’s
license.
A blood relationship between Applicant I and Applicant II must not be closer than
first cousins.
Blood tests are not required.
The fee for a license is $60.00 (plus $5.00 portal administration cost), payable at
the time of filing the application.
INSTRUCTIONS FOR FILLING OUT APPLICATION FORM
Please use black ink. Print information so that it can be read easily. If you
have a home or office telephone, give number in left margin. Do not sign the
application until the marriage license agent asks you to do so. It must be signed in
his or her presence.
Name of Applicant I and Applicant II. Enter the full first, middle, and last names.
Do not use abbreviations or initials.
Date of Birth. Enter the exact month, day and year. Enter the full name of the
month January, February, March, etc.
Usual residence. Give street address, if any, and enter the name of the city or
town in full and the county. Enter zip code number in space provided in left
margin. If no street address, enter name of town or village. Mailing address may be
used but must be enclosed in parenthesis before the name of the town or village.
DO NOT USE MAILING ADDRESS ALONE.
Place of birth. For Applicant I and Applicant II, give city or town and state, or city
or town and foreign country.
Father and mother. Enter full first, middle, and last names without abbreviations
or initials. For mother, enter full maiden name. For place of birth, enter state or foreign
country only. After “Living?” state “yes” or “no,” or “unknown.”
Blood relationship of Applicant I to Applicant II. Generally, the entry here will be
“none.”
In what county do you plan to be married? Honolulu County, Hawai‘i
County, Maui County, or Kaua‘i County.
When do you plan to be married? Date of ceremony must be within 30 days
of application.
Name of marriage performer. Person who is to perform the marriage
ceremony.
Note: Hawai‘i state law requires that the person performing the marriage
ceremony must be licensed by the State of Hawai‘i, Department of Health;
otherwise, the marriage may be declared invalid (Sec. 572-1-8, HRS).
Forwarding address (After marriage). Enter mailing address where you would
like the certified copy of your marriage certificate to be sent.
Do you want your names published in the newspaper? Names printed on a
space available basis as a public service; no charge. (May not be available on all
islands).
Number of this marriage/other legal union. First, second, third, etc.
If previously married or in other legally recognized union. State how your last
marriage/other legal union ended, i.e., by death, divorce, dissolution, annulment or
termination. Then enter the date and place of death, divorce, dissolution, annulment
or termination.
Race. Use such terms as Japanese, Caucasian, Black, Hawaiian, etc. Using
the term Hawaiian may be advantageous, if appropriate.
Occupation. Give your usual occupation, such as: carpenter; bookkeeper;
student; sales clerk; auto mechanic; soldierU.S. Army; sailorU.S. Navy; or
officerU.S. Army; officerU.S. Navy; etc. (Give kind of work done during most of
working life, even if retired).
Education. Enter the number of the highest grade completed in “regular
schooling in the space for elementary/secondary or college.
Note: Do not enter any other kind of schooling or training. Although beauty
and barber schools, business or trade schools and the like, are important, they are
not considered “regular” schools for the purpose of this item.
Confidential Information. Information on previous marriage, race, occupation
and education is confidential and will not be reproduced on certified copies of
your marriage certificate but used for statistical purposes only.
* Do not leave these items blank. Enter “refused. rev 12/2013
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